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OP025 Local anesthetic neurotoxicity and arachnoiditis: a systematic review of cases
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  1. Catherine Poots1,
  2. Connor Brenna2,
  3. Shawn Khan3 and
  4. Richard Brull4
  1. 1Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Canada
  2. 2Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada, University of Toronto, Toronto, Canada
  3. 3Faculty of Medicine, University of Toronto, Toronto, ON, Canada, University of Toronto, Toronto, Canada
  4. 4Department of Anesthesia, Women’s College Hospital, Toronto, ON, Canada, University of Toronto, Toronto, Canada

Abstract

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Background and Aims Arachnoiditis is a rare but devastating disorder caused by a variety of insults, one purported to be local anesthetic (LA) neurotoxicity following neuraxial blockade. We examined reported cases of arachnoiditis attributed to LA neurotoxicity to characterize the strength of association.

Methods A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and pre-registered through the Open Science Framework (https://osf.io/b6txa). The databases Medline, EMBASE, CINAHL, and Cochrane CENTRAL were searched (from inception to December 2022) for articles attributing arachnoiditis to LA following neuraxial anesthesia.

Abstract OP025 Figure 1

Geographical distribution of reported cases of arachnoiditis attributed to local anesthetic neurotoxicity and completeness of data reporting

Abstract OP025 Table 1

Combined spinal-epidural procedural characteristics

Results We screened 1158 studies and 38 met inclusion criteria, all of which were case reports or series representing a total of 129 patient cases with ages ranging from 15-67 years. Over half of studies were published prior to this century and inconsistent with modern practice. Neuraxial techniques included 76 epidurals, 47 spinals, and 6 combined spinal-epidurals (table 1). Completeness of reported data was poor (figure 1). Studies reporting the greatest number of cases and/or originating from Western countries had the least complete data. Overall, more than half (74) of the 129 patients with arachnoiditis attributed to LA neurotoxicity experienced a complicated needle or catheter insertion, including memorable paresthesia, pain, or multiple attempts, irrespective of the type of neuraxial block.

Conclusions The aggregate evidence attributing arachnoiditis to LA neurotoxicity is largely outdated, incomplete, or both, and insufficient to characterize the strength of association. However, there appears to be an association between complicated or traumatic insertion and arachnoiditis.

  • Local Anesthetic
  • Neurotoxicity
  • Arachnoiditis

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